Burnout results from “chronic workplace stress that has not been successfully managed” (WHO). Within the NHS and other healthcare systems this stress is caused by a vicious cycle of increasing demand, underfunding and staff shortages.
Whilst the causes of burnout are systemic in nature, the impact is very personal. Burnout results in exhaustion, anxiety and disconnection and can have serious implications for physical and mental health, relationships and careers.
Understanding the psychological mechanisms underlying the process of burnout won’t resolve the underlying causes – but it can help to mitigate the impact and empower recovery and restoration.
The three-system model of emotion
Paul Gilbert’s three-system model of emotion describes how we have three basic emotion systems: threat, drive and soothing. These systems each have different, but important, functions. The threat system alerts us to potential danger and urges us to take action to protect ourselves. The drive system enables us to attend to opportunities in our environment and motivates us to pursue our goals. Finally, the soothing system helps us to rest and digest and to feel calm, safe and content.
We need all three systems to be in balance for us to function well. Very often, however, these systems are out of balance, and we find that our threat and drive systems are more often and more easily activated than our soothing system. In fact, for many of us, our soothing system wastes away from disuse, so that in times of stress when we could really do with some soothing, we’re so horribly out of practice that we struggle to access it all.
Threat + drive = burnout
If you’re a healthcare professional you’re very likely to have highly activated threat and drive systems. In fact the training process of many health professions actively selects for this. In order to survive the gruelling training, and work under the austere conditions of public healthcare, you will need to be highly responsive to threat, both clinical and social – you don’t want to let people down, make mistakes or cause harm.
Unfortunately the system we work in is often also very threat-based – threats of complaint, litigation and disciplinary action. Many health professionals frequently face verbal and physical assault from patients and members of the public. Bullying and racism is commonplace.
It’s no wonder our threat systems our highly active.
We are taught to respond to this through activation of the drive system – working harder and longer; striving for perfection; enacting defensive bureaucratic processes. When you feel stressed or overwhelmed by work what do you do? If you’re anything like me you’ll probably try desperately to problem-solve, make lists, do some CPD, set up new processes, or put more hours in. Our systems respond in the same way – more meetings, more tick boxes, more “transformation”.
Often this works well. Usually the more you study the better you’ll do in the exam. As humans we have an incredible capacity for innovation and problem-solving. But – and it’s an important but – this only goes so far, for two key reasons:
1.If we continually rely on our drive system to regulate our threat system we will become exhausted.
2. Not all problems can be fixed. We can’t eliminate risk or pain, we will make mistakes, and we don’t always have the power to change what needs to be changed. Acknowledging this activates our threat system, and if our only option for regulating this is our drive system – see point 1
A vicious cycle of oscillation between threat and drive ensues. Often we think we can get ourselves out of this vicious cycle by numbing or distraction. We avoid and procrastinate. We seek refuge in alcohol, sugar or drugs. We spend countless hours on Netflix or social media. Sometimes this gives us respite, but it’s usually short lived and can create its own threats that merely feed the cycle.
Getting locked into this threat-drive cycle is how we burn out. We find ourselves increasingly exhausted, anxious and disconnected. The more we put in, the less we get out. We can end up feeling stuck and hopeless.
The soothing system
But often we have forgotten the third system – the soothing system. This system is inherent in all mammals, and vital for our survival. It’s the system that enables us to care for ourselves and others, and to feel connected to and cared for by others. It enables us to rest and digest, and to feel safe and calm.
We need to have this system online so that we have alternative ways of responding to threat, and so that we can replenish our energies and nurture our drive system.
As healthcare professionals we often are very neglectful of the soothing system. Cultivating this can seem alien, and even scary. People often fear that opening up to the soothing system will dampen their drive and make things worse – they’ll get “lazy” or lose their sense of identity and self-worth. But the soothing system is there to support the drive system – not to replace it. And the alternative, to keep on going in this vicious cycle of drive and threat, is going to derail at some point.
4 ways to cultivate the soothing system
Cultivating and supporting the soothing system can be done through intentional practice. Have a think about the times when you notice yourself connecting with a sense of safety, calm, kindness and positive bonds with others. What are the ingredients of those experiences? How can you bring more of that into your life?
Here are 4 ideas for cultivating your soothing system:
1.Connecting with others – spending time with people who make you feel good. When we are struggling we often start to isolate ourselves and cut off from others. Reach out to people in and out of work who make you laugh, are supportive or who you feel safe with.
2. Breath work – connecting with our bodies is an important part of cultivating the soothing system. We need to be able to attend to our nervous systems, and we can learn to respond in ways that promote calm and self-care. Soothing Rhythm Breathing is a great way to get started with this.
3. Using imagery and memory – our imaginations can be a powerful resource. The Compassionate Mind Workbook offers a range of really helpful exercises such as soothing colour imagery, creating a safe place, and tapping into memories of being cared for.
4. Creativity – although creative pursuits often activate the drive system by giving us a sense of achievement, they can also be used to intentionally cultivate the soothing system. Knitting, for example, is a craft that can help us slow down, tune into our own needs, foster self-compassion and connect with others. The repetitive movements, portability and tactile nature make it a great resource for activating the soothing system.
If you already have a creative hobby think about ways you can adapt it to more intentionally support your soothing system. And if you’re a knitter check out our Creative Restoration retreats.
